Polypill beats monotherapy for hypertension: results from the QUARTET stud

By Ahmed El-Medany

Treatment with a ‘quadpill’ containing quarter doses of four antihypertensive drugs demonstrated better blood pressure control than initial monotherapy with full-dose irbesartan, according to findings from the phase III QUARTET trail, which was presented at the ESC Congress 2021.

QUARTET was a multicentre, double-blind, parallel-group, randomised trial among Australian adults with hypertension, who were untreated or receiving monotherapy. Participants were randomly assigned to either treatment with the quadpill (containing irbesartan at 37.5 mg, amlodipine at 1.25 mg, indapamide at 0.625 mg, and bisoprolol at 2.5 mg) or an indistinguishable monotherapy control (irbesartan 150 mg). If target blood pressure was not achieved, additional medications could be added in both groups, starting with amlodipine at 5 mg. The primary outcome was difference in office systolic blood pressure at 12 weeks.

300 participants were randomly assigned to quadpill treatment, and 291 to monotherapy treatment. Systolic blood pressure was lower by 6.9 mm Hg (95% CI 4·9–8·9; p<0·0001) and blood pressure control rates were higher in the quadpill group (76%) versus monotherapy group (58%; relative risk [RR] 1·30, 95% CI 1·15–1·47; p<0·0001).

More at the Lancet

Chow CK, Atkins ER, Hillis GS, Nelson MR, Reid CM, Schlaich MP, Hay P, Rogers K, Billot L, Burke M, Chalmers J. Initial treatment with a single pill containing quadruple combination of quarter doses of blood pressure medicines versus standard dose monotherapy in patients with hypertension (QUARTET): a phase 3, randomised, double-blind, active-controlled trial. The Lancet. 2021 Aug 29.